Cystatin C combined with prothrombin time for assessing the condition and outcome of patients with severe fever with thrombocytopenia syndrome
石光顺 1夏冬梅 1朱立雨2
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作者信息
1. 安徽医科大学附属巢湖医院检验科,合肥 238000
2. 安徽医科大学附属巢湖医院感染疾病科,合肥 238000
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摘要
目的 探讨早期胱抑素C(Cys-C)联合凝血酶原时间(PT)在发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者病情严重程度及预后中的评估价值.方法 回顾性收集2021年4月至2023年8月安徽医科大学附属巢湖医院诊治的101例SFTS患者资料,按患者病情严重程度分为普通组和重症组,按治疗结局分为生存组和死亡组.分析各组临床表现及早期实验室指标差异,采用logistic回归分析影响预后的因素,并采用受试者工作特征(ROC)曲线评估早期Cys-C水平及PT单独及联合检测对预测生存及死亡结局的效能.结果 早期患者血清Cys-C、尿素氮、肌酐、尿酸、肌酸激酶、肌酸激酶同工酶水平、PT、活化部分凝血活酶时间在重症组及死亡组高于普通组及生存组,而淋巴细胞计数低于后两组,差异具有统计学意义(P＜0.05).多因素二元logistic回归分析结果提示,患者年龄(OR=1.146,95％CI:1.036～1.267)、PT(OR=2.643,95％CI:1.323～5.281)、Cys-C(OR=5.039,95％CI:1.548～16.395)是SFTS患者预后的独立危险因素.血清Cys-C作为预测生存者与死亡者的指标具有较高评估价值,ROC曲线下面积为0.831;而联合Cys-C、PT和患者年龄,曲线下面积高达0.930.结论 SFTS多发生于农民及老年人群,患者入院早期血清PT和Cys-C水平可有效预估患者预后,两者有望成为预测生存和死亡的生物标志物.
Abstract
Objective To investigate the value of early cystatin C(Cys-C)combined with prothrombin time(PT)for assessing the severity and outcome of patients with severe fever with thrombocytopenia syndrome(SFTS).Methods The data of 101 patients with SFTS diagnosed and treated in Chaohu Hospital of Anhui Medical University from April 2021 to August 2023 were reviewed retrospectively.The patients were assigned to non-severe group or severe group according to the severity of the disease,and assigned to survivors group or deaths group according to the treatment outcome.The clinical manifestations and early laboratory test results were compared between groups.Logistic regression model was used to analyze the factors for predicting the outcome.The receiver operating characteristic(ROC)curve was used to evaluate the ability of Cys-C and PT levels alone and in combination to distinguish survivors from deaths.Results In the early stage,the patients in severe group and deaths group showed significantly higher levels of serum Cys-C,blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),PT,activated partial thromboplastin time(APTT),creatine kinase(CK)and creatine kinase MB(CKMB)but significantly lower lymphocyte count compared to the patients in the non-severe group and survivors group(P＜0.05).Multivariate binary Logistic regression analysis showed that age(OR=1.146,95％CI:1.036-1.267),PT(OR=2.643,95％CI:1.323-5.281),and Cys-C(OR=5.039,95％CI:1.548-16.395)were independent risk factors for the outcome of SFTS patients.Serum Cys-C was valuable in distinguishing survivors from deaths,the area under the ROC curve of which was 0.831.When Cys-C,PT and age were combined,the AUC was up to 0.930.Conclusions SFTS mainly occurs in farmers and elderly people.Serum PT and Cys-C levels at early stage can effectively predict the outcome of patients with SFTS.PT and Cys-C levels are expected to be biomarkers for distinguishing survivors from deaths.
关键词
发热/血小板减少综合征/胱抑素C/预后
Key words
severe fever/thrombocytopenia syndrome/cystatin C/outcome
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